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Outcome and Quality of Life in Patients Treated for Abdominal Aortic Aneurysms: A Single Center Experience

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Abstract

Background

Durability of protection and long-term quality of life (QoL) are critical outcome parameters of abdominal aortic aneurysm (AAA) repair. The aim of the present study was to compare results of endovascular and open aneurysm repair (EVAR and OR) with adjusted standard populations, including stratification for urgency of presentation.

Methods

Retrospective analysis of prospectively collected data of 401 consecutive patients presenting with AAA between January 1998 and December 2002. Cross-sectional follow up was 58 ± 29 months. Patients were grouped into three cohorts: elective EVAR (n = 68), elective OR (n = 244), and emergency OR (including symptomatic and ruptured AAA, n = 89). Endpoints were perioperative (i.e., 30 days or in-hospital) and late mortality rates, as well as long-term QoL as assessed by the Short Form health survey questionnaire (SF-36).

Results

Mean age was lower in the elective OR cohort (66 ± 10 years) than in the EVAR cohort (72 ± 7 years; p < .05). Perioperative mortality rates were 4.4%, 0.4%, and 10.1%, for the EVAR, elective OR, and emergency OR cohorts, respectively (p < .05). Corresponding cumulative survival rates after 4 years were 67%, 89%, and 69%, respectively. Long-term QoL SF-36 scores were in all cohorts similar to age- and gender-adjusted standard populations, which score between 85 and 115: 99.6 ± 35.8 (EVAR), 101.3 ± 32.4 (elective OR), and 100.4 ± 36.5 (emergency OR).

Conclusions

Long-term QoL is not permanently impaired after AAA repair, but returns in long-term survivors to what would be expected in a standard population. In this respect, differences were found neither between EVAR and OR, nor between elective and emergency repair. Perioperative mortality rates were highest in patients undergoing emergency OR. The outlook for such patients after the perioperative period, however, was similar to that for patients undergoing elective repair.

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References

  1. Dardik A, Lin JW, Gordon TA et al (1999) Results of elective abdominal aortic aneurysm repair in the 1990s: a population-based analysis of 2335 cases. J Vasc Surg 30:985–995

    Article  PubMed  CAS  Google Scholar 

  2. Hertzer NR, Mascha EJ, Karafa MT et al (2002) Open infrarenal abdominal aortic aneurysm repair: the Cleveland Clinic experience from 1989 to 1998. J Vasc Surg 35:1145–1154

    Article  PubMed  Google Scholar 

  3. Mangione CM, Goldman L, Orav EJ et al (1997) Health-related quality of life after elective surgery: measurement of longitudinal changes. J Gen Intern Med 12:686–697

    Article  PubMed  CAS  Google Scholar 

  4. Tambyraja AL, Fraser SC, Murie JA et al (2004) Quality of life after repair of ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 28:229–233

    Article  PubMed  CAS  Google Scholar 

  5. Greenhalgh RM, Brown LC, Epstein D et al (2005) Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 365:2179–2186

    Article  Google Scholar 

  6. Blankensteijn JD, de Jong SE, Prinssen M et al (2005) Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med 352:2398–2405

    Article  PubMed  CAS  Google Scholar 

  7. Blankensteijn JD, Lindenburg FP, Van der Graaf Y et al (1998) Influence of study design on reported mortality and morbidity rates after abdominal aortic aneurysm repair. Br J Surg 85:1624–1630

    Article  PubMed  CAS  Google Scholar 

  8. Greenhalgh RM, Brown LC, Kwong GP et al (2004) Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 364:843–848

    Article  PubMed  CAS  Google Scholar 

  9. Prinssen M, Verhoeven EL, Buth J et al (2004) A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351:1607–1618

    Article  PubMed  CAS  Google Scholar 

  10. Brewster DC (2002) Do current results of endovascular abdominal aortic aneurysm repair justify more widespread use? Surgery 131:363–367

    Article  PubMed  Google Scholar 

  11. Holzenbein TJ, Kretschmer G, Thurnher S et al (2001) Midterm durability of abdominal aortic aneurysm endograft repair: a word of caution. J Vasc Surg 33:S46–S54

    Article  PubMed  CAS  Google Scholar 

  12. Laheij RJ, Buth J, Harris PL et al (2000) Need for secondary interventions after endovascular repair of abdominal aortic aneurysms. Intermediate-term follow-up results of a European collaborative registry (EUROSTAR). Br J Surg 87:1666–1673

    Article  PubMed  CAS  Google Scholar 

  13. Prinssen M, Buskens E, Blankensteijn JD (2004) Quality of life endovascular and open AAA repair. Results of a randomised trial. Eur J Vasc Endovasc Surg 27:121–127

    Article  CAS  Google Scholar 

  14. van Marrewijk C, Buth J, Harris PL et al (2002) Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: The EUROSTAR experience. J Vasc Surg 35:461–473

    Article  PubMed  Google Scholar 

  15. Beattie DK, Golledge J, Greenhalgh RM et al (1997) Quality of life assessment in vascular disease: towards a consensus. Eur J Vasc Endovasc Surg 13:9–13

    Article  PubMed  CAS  Google Scholar 

  16. Korhonen SJ, Kantonen I, Pettila V et al (2003) Long-term survival and health-related quality of life of patients with ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 25:350–353

    Article  PubMed  CAS  Google Scholar 

  17. Bown MJ, Sutton AJ, Bell PR et al (2002) A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg 89:714–730

    Article  PubMed  CAS  Google Scholar 

  18. Seiwert AJ, Elmore JR, Youkey JR et al (1995) Peter B. Samuels Award. Ruptured abdominal aortic aneurysm repair: the financial analysis. Am J Surg 170:91–96

    Article  PubMed  CAS  Google Scholar 

  19. Dick F, Diehm N, Galimanis A et al (2007) Surgical or endovascular revascularization in patients with critical limb ischemia: influence of diabetes mellitus on clinical outcome. J Vasc Surg 45:751–761

    Article  PubMed  Google Scholar 

  20. Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481

    Article  Google Scholar 

  21. Bland JM, Altman DG (1997) Cronbach’s alpha. BMJ 314:572

    PubMed  CAS  Google Scholar 

  22. Sullivan M, Karlsson J, Ware JE (1994) SF-36 health questionnaire. Swedish manual and interpretation guide

  23. Ware JE, Snow KK, Kosinski M (1993) SF-36 health survey manual and interpretation guide

  24. Immer FF, Barmettler H, Berdat PA et al (2002) Effects of deep hypothermic circulatory arrest on outcome after resection of ascending aortic aneurysm. Ann Thorac Surg 74:422–425

    Article  PubMed  Google Scholar 

  25. Dubost C, Allary M, Oeconomos N (1952) Resection of an aneurysm of the abdominal aorta: reestablishment of the continuity by a preserved human arterial graft, with result after five months. Arch Surg 64:405–408

    CAS  Google Scholar 

  26. First Vascunet Database Report (2007) The European Society for Vascular Surgery. ISBN 1-903968-17-8

  27. Magee TR, Scott DJ, Dunkley A et al (1992) Quality of life following surgery for abdominal aortic aneurysm. Br J Surg 79:1014–1016

    Article  PubMed  CAS  Google Scholar 

  28. Hennessy A, Barry MC, McGee H et al (1998) Quality of life following repair of ruptured and elective abdominal aortic aneurysms. Eur J Surg 164:673–677

    Article  PubMed  CAS  Google Scholar 

  29. Aquino RV, Jones MA, Zullo TG et al (2001) Quality of life assessment in patients undergoing endovascular or conventional AAA repair. J Endovasc Ther 8:521–528

    Article  PubMed  CAS  Google Scholar 

  30. Lloyd AJ, Boyle J, Bell PR et al (2000) Comparison of cognitive function and quality of life after endovascular or conventional aortic aneurysm repair. Br J Surg 87:443–447

    Article  PubMed  CAS  Google Scholar 

  31. Arko FR, Hill BB, Reeves TR et al (2003) Early and late functional outcome assessments following endovascular and open aneurysm repair. J Endovasc Ther 10:2–9

    Article  PubMed  Google Scholar 

  32. Malina M, Nilsson M, Brunkwall J et al (2000) Quality of life before and after endovascular and open repair of asymptomatic AAAs: a prospective study. J Endovasc Ther 7:372–379

    Article  PubMed  CAS  Google Scholar 

  33. Immer FF, Lippeck C, Barmettler H et al (2004) Improvement of quality of life after surgery on the thoracic aorta: effect of antegrade cerebral perfusion and short duration of deep hypothermic circulatory arrest. Circulation 110:II250–II255

    Article  PubMed  Google Scholar 

  34. Crawford ES (1991) Ruptured abdominal aortic aneurysm. J Vasc Surg 13:348–350

    Article  PubMed  CAS  Google Scholar 

  35. Eckstein HH, Bruckner T, Heider P et al (2007) The relationship between volume and outcome following elective open repair of abdominal aortic aneurysms (AAA) in 131 German hospitals. Eur J Vasc Endovasc Surg 34:260–266

    Article  PubMed  Google Scholar 

  36. Mehta T, Venkata Subramaniam A, Chetter I et al (2006) Assessing the validity and responsiveness of disease-specific quality of life instruments in intermittent claudication. Eur J Vasc Endovasc Surg 31:46–52

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank our biostatistician, Brigitta Gahl, MSc, for invaluable help with the analyses. Florian Dick was granted stipendiary support from the Swiss National Funds (SNF, PBBSB-120858) and the Margarete und Walter Lichtenstein Stiftung, Basel, for an independent vascular research fellowship during part of his time.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Inselspital, University Hospital Bern, and University of Bern, Berne, 3010, Switzerland

    Florian Dick, Véronique Grobéty, Franz F. Immer, Hannu Savolainen, Thierry P. Carrel & Jürg Schmidli

  2. Division of Clinical and Interventional Angiology, Swiss Cardiovascular Center, Inselspital, University Hospital Bern, and University of Bern, Bern, 3010, Switzerland

    Dai Do Do

Authors
  1. Florian Dick
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  2. Véronique Grobéty
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  5. Hannu Savolainen
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Correspondence to Franz F. Immer.

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Dick, F., Grobéty, V., Immer, F.F. et al. Outcome and Quality of Life in Patients Treated for Abdominal Aortic Aneurysms: A Single Center Experience. World J Surg 32, 987–994 (2008). https://doi.org/10.1007/s00268-008-9565-1

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